Attachment B Sample High Claims.pdf
PDF 114 KB Posted
- Attached to
- High Claims Medical Bill Auditor
- Solicitation number
- S000000320
- Issued by
- Pulaski County, Little Rock City, Arkansas
About this file
This document is a High Dollar Claim Report for the ArBenefits state health plan of Arkansas, which covers claims greater than or equal to $75,000 with activity from 1/1/2023 through 3/19/2024. The report lists 16 sample claims with details on the Charged Amount, Allowed Amount, and Paid Amount.
The related state and local contract opportunity is for a High Claims Medical Bill Auditor to support the state of Arkansas and the local jurisdictions of Pulaski County and Little Rock City. The scope of work and project details are not provided in this document.
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Text version
ArBenefits - High Dollar Claim Report Printed On 3/19/2024
Claims greater than or equal to $75,000.00 with activity from 1/1/2023 through 3/19/2024
Sample Claim Charged Amount Allowed Amount Paid Amount
2JZN $151,550.02 $100,461.72 $99,063.02
2R72 $251,480.70 $195,776.05 $195,162.95
31SA $1,153,796.31 $538,992.31 $538,992.31
293O $275,620.08 $110,393.33 $110,393.33
1095 $267,534.89 $95,895.97 $95,808.68
3AZ6 $423,323.41 $110,203.56 $110,203.56
38KY $269,311.52 $136,309.56 $136,309.56
2AZ0 $162,601.24 $151,695.54 $151,695.54
1624 $490,350.40 $118,281.42 $116,831.69
26SP $126,920.92 $114,025.72 $114,025.72
26K2 $583,655.56 $186,199.36 $186,172.32
2W7N $105,575.34 $105,575.34 $105,575.34
2BFJ $1,984,608.24 $1,313,242.87 $1,313,242.87
0380 $93,350.55 $92,988.00 $92,988.00
1791 $119,820.65 $104,679.34 $104,679.34
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